Publication in the field of spirituality, religion, and medicine: an uphill battle?

Attention to religion, faith, and spirituality in medicine has increased in recent years. The number of papers published on the subject has skyrocketed in the decade of the 90s, and the pace has continued in the new millennium. The topic has been the subject of a number of popular books, including best sellers such as Koenig's "The Healing Power of Faith" (Simon and Schuster) and Newberg's "Why God Won't Go Away" (Ballantine). However, a troubling paradox has occurred--while the topic is popular with patients and the public, it has not attracted the attention of major funding agencies or major medical journals. Why is this so, and what should be done?

In this issue of the Journal, Weaver et al (1) document the lack of papers on the subject of religion, faith, and spirituality in the three most important general medical journals. Essentially, the most influential editors have ignored the field. Furthermore, after a flurry of initial interest, the National Institutes of Health (NIH), particularly the National Center for Complementary and Alternative Medicine (NCCAM), have lost interest in funding religion and health projects. A quick perusal of the NCCAM program announcements will reveal programs on cancer, chromium, chronic fatigue, and ethics but no initiatives focusing on faith, religion, and medicine. This discrepancy persists despite the presence of more than 1,200 studies in this general topic area that can be found in Koenig's "Handbook of Religion and Health" (Oxford University Press, 2001). Clearly, major editors and sponsors of research are staying away from the subject.

Many reasons for this state of affairs are given, such as, "the science is not there," "no good studies exist," and "few research proposals have been submitted." However, these remarks simply do not tell the whole story. Truly, it appears unrealistic to suggest that no good studies have been conducted. Certainly the quality of studies in the field has not been consistent, and there is vast room for improvement. However, numerous high-quality studies have been published in peer-reviewed journals that enjoy wide readership. David Larson, MD, past president of the International Center for the Integration of Health and Spirituality (ICIHS) and a leading figure in mental health and spirituality, published more than 100 papers in the field. Harold Koenig, MD, an Associate Professor of Medicine and Psychiatry at Duke University Medical Center and Director and founder of the Center for the Study of Religion/Spirituality and Health, has also published well over 150 papers and numerous books, including a bestseller. However, only recently was his work accepted for publication in the Journal of the American Medical Association, and only then in the less controversial "Case Discussion" section. Dr. Koenig, who has well-established credentials, is the editor of two journals, and his research is funded by the NIH--but he appears to go without the traditional recognition afforded to more mainstream investigators.

A bias against publishing religion and health studies appears evident in the major general medical journals. Dr. Larson used to ruminate about the "anti-tenure" factor, a tool of bias he often saw while he was mentoring and counseling young researchers in his field. It was Larson's notion that pursuing studies of religion and medicine saddled the investigator with a mystic hurdle that had to be overcome if one wished to be taken seriously in academia. He established the National Institute of Healthcare Research (later called the ICIHS) more than 10 years ago, in an attempt to legitimize and recognize the research being done in the field of religion and health. His efforts were translating into real progress until his untimely death in 2002. The ICIHS conference at NIH in the spring of 2003 brought together a dedicated group of researchers in the field to discuss the latest opportunities and findings. However, instead of the event being a grand launching pad for the next phase of the movement, it was the end of an era, as ICIHS soon closed its doors. This development has left a great void where there was once vibrant advocacy.

This decline in visible support for the concepts of spirituality and medicine and mental health is unfortunate: recent findings confirm the desire of a large proportion of patients who want to have their spiritual needs addressed when suffering medical illness. (2) The increasing number of outpatient pastoral counseling centers (eg, American Association of Pastoral Counselors) that are being established all across the United States provide new access to religiously sensitive counseling for patients of all faiths. Recent research documenting the association between religious participation, spirituality, and the stress/inflammation systems provide even more reason to continue current lines of research. (3,4)

So what is to be done? We need dedicated, creative academic minds to continue (in their closets and basements?) to explore the relation between religion and health, and to mentor new researchers in the field. As for funding opportunities, John Templeton Foundation still funds innovative programs. The Duke Endowment has announced a spirituality and health funding initiative. The Fetzer Institute has a program on end-of-life research. NIH funding is available to people who can be creative in addressing spiritual and other medical issues simultaneously. With continued effort, some day soon, the quality of the research and the impact of this field will combine to overwhelm the biases against it, and we will see this work published routinely in the most reputable journals.

We are not human beings seeking a spiritual experience; we are spiritual
beings seeking a human experience.
--Teilhard de Chardin

Accepted December 19, 2004.

Please see "Religion and Spirituality in Three Major Medical Journals from 1998 to 2000" on page 1245 of this issue.

References

1. Weaver AJ, Flannelly KJ, Case DB, Costa KG. Religion and spirituality in three major general medical journals from 1998 to 2000. South Med J 2004;97:1245-1249.

2. MacLean CD, Susi B, Phifer N, et al. Patient preference for physician discussion and practice of spirituality. J Gen Intern Med 2003;18:38-43.

3. Ironson G, Solomon GF, Balbin EG, et al. The Ironson-Woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS. Ann Behav Med 2002;24:34-48.

4. King DE, Mainous AG III, Pearson WS. C-reactive protein, diabetes, and attendance at religious services. Diabetes Care 2002;25:1172-1176.

Dana E. King, MD

From the Department of Family Medicine, Medical University of South Carolina, Charleston, SC.

Reprint requests to Dr. Dana King, 295 Calhoun Street, PO Box 250192, Charleston, SC 29425. E-mail: [e-mail]